Care and secrecy: Being a mother of children living with HIV in Burkina Faso

Home care has become a central component of the response to the HIV/AIDS epidemic, displacing caregiving work onto women. While increasing interest has been paid to HIV/AIDS care with a focus on ailing adults and orphan foster care, the issue of caring for children living with HIV has received little attention in the social sciences. Based on ethnographic material gathered in Burkina Faso between November 2005 and December 2006, the aim of this paper was to gain understanding of women who mother and care for children living with HIV in resource-limited countries. The study involved participant observation in community-based organizations in Burkina Faso and semi-structured interviews with 20 women mothering HIV-positive children as well as 15 children infected with HIV, aged between 8 and 18 years. In daily care mothers face many great challenges, ranging from the routine of pill-taking to disturbing discussions with children asking questions about their health or treatment. The results also show how HIV/AIDS-related stigma adds an additional layer to the burden of care, compelling mothers to deal with the tension between secrecy surrounding the disease and the openness required in providing care and receiving social support. As mothers live in fear of disclosure, they have to develop concealment strategies around children's treatment and the nature of the disease. Conversely, some mothers may share their secret with kin members, close relatives or their children to gain social support. As HIV/AIDS care is shaped by secrecy, these findings shed light on mothers' isolation in child care within a context of changing patterns of family bonds and lack of formal psychosocial support addressing child-related issues. Finally, women's engagement in child care invites us to look beyond the essentialist approach of women's vulnerability conveyed by international discourse to characterise the situation of women facing the HIV/AIDS impact.     

The vulnerability of orphans in Thyolo District, southern Malawi

It is estimated that Malawi has about 900,000 orphans, the majority of whom are orphaned as a result of AIDS. Orphans in rural areas are mostly neglected by economic and social empowerment initiatives. This study was conducted to explore the living situation of orphans in rural Thyolo District, southern Malawi. Qualitative methodology was used in data collection and analysis to explore orphan children's living situation and specifically with regard to access to health care, education, food and basic needs. In addition, issues of love and companionship, discrimination and the future. Twenty-three orphan children and four adults were interviewed. The children reported experience with lack of food, school drop out and truancy, lack of social support to obtain present needs and prepare for the future. Public health programs aimed to prevent and mitigate the effects of AIDS in Malawi should be tailored to provide support to orphan children.     

Association Between Family Composition and the Well-Being of Vulnerable Children in Nairobi, Kenya

The objective of this study is to examine the relationship between a vulnerable child??s family composition (family size and primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using 2006?C2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424 children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals to examine the relationship between family composition measures and child well-being. Multivariate results were also stratified by orphan status. Vulnerable children who live in household sizes of 4?C6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR?=?1.51, 95% CI: 1.13?C2.01, OR?=?9.02, 95% CI: 4.62?C17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR?=?0.19, 95% CI 0.07?C0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related to childhood immunization education and intervention programs. The findings also underscore the need for policies which support families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development designed to meet needs of vulnerable children.     

Children, AIDS and the politics of orphan care in Ethiopia: the extended family revisited

The astounding rise in the number of orphans due to the HIV/AIDS epidemic has left many Ethiopian families and communities with enormous childcare problems. Available studies on the capacity and sustainability of the extended family system, which culturally performs the role of care for children in need, suggest two competing theories. The first is grounded in the social rupture thesis and assumes that the traditional system of orphan care is stretched by the impact of the epidemic, and is actually collapsing. By contrast, the second theory counter-suggests that the flexibility and strength of the informal childcare practise, if supported by appropriate interventions, can still support a large number of orphans. Based on a seven-month period of child-focused, qualitative research fieldwork in Ethiopia involving observations; in-depth interviews with orphans (42), social workers (12) and heads of households (18); focus group discussions with orphans (8), elderly people and community leaders (6); and story-writing by children in school contexts, this article explores the trade-offs and social dynamics of orphan care within extended family structures in Ethiopia. It argues that there is a rural-urban divide in the capacity to cater for orphans that emanates from structural differences as well as the socio-cultural and economic values associated with children. The care of orphans within extended family households is also characterised by multiple and reciprocal relationships in care-giving and care-receiving practices. By calling for a contextual understanding of the 'orphan burden', the paper concludes that interventions for orphans may consider care as a continuum in the light of four profiles of extended families, namely rupturing, transient, adaptive, and capable families.     

West African children in private foster care in City and Hackney

A unique feature of some Africans who come to study and work in Britain is the practice of making private arrangements to send their children to live with foster parents who assume full parental rights. Six hundred randomly selected African families, with a child born between June 1988 and May 1991, resident in one Health Authority, were sent a questionnaire to elicit the proportion of children who had been in private foster care and to gain information on the knowledge and attitudes to fostering and day care provision. Families with children in foster care were asked additional questions about their experiences. Two hundred and six (34%) of the questionnaires were analysed. Seventy-six per cent of the respondents were from Nigeria, 65% had already heard about private fostering and 29 (14%) had sent one of their children to private foster care. Only one family felt that foster care was a suitable option; the reminder would have preferred alternative facilities such as nursery placement. Of the 29 children in foster care, nine parents said their children were unhappy and five rated the foster parents as bad. Contrary to popular belief, most children were visited fortnightly, some more frequently and only two never visited. Private fostering in this group of children was found to be less common than in earlier studies.     

Vulnerability of street-involved children and youth in semi-rural Kenya: does orphan status matter?

The vulnerability of street-involved children and youth (SICY) in sub-Saharan Africa (SSA) to adverse childhood events is well documented. Associations between orphanhood and multiple types of vulnerability have also been demonstrated. Whether type of orphanhood is associated with adverse events experienced during childhood or is predictive of psychosocial health is still unclear. Maua Methodist Hospital conducted a cross-sectional survey of 53 semi-rural SICY. Multiple indicators of vulnerability, including educational attainment, income, food security, adverse childhood events and psychosocial health (resilience, self-esteem, depression and self-efficacy), were analysed to determine differences between orphan status groups. Though not statistically significant, paternal and double orphans reported several factors that suggested greater vulnerability to adverse experiences and outcomes on the streets. Maternal and double orphans reported significantly more adverse childhood experiences than paternal orphans, suggesting survival of the mother may be a protective factor. Double orphans had significantly higher depression scores than each of the other orphan groups. Within a rescue and rehabilitation program, children who have lost both parents may need extra psychological support and intervention. Paternal and double orphans still living on the street may face greater obstacles to escaping street life and are a high priority for both prevention and intervention programming.     

Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning,Meaningfulness of Life,Seroconcordance, Social Support and Considering the Need for Integrated Care

As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.     

How do Kenyan orphan girls experience less meaningful lives and how much does it matter for ‘health’?

Background

Currently, 2.5 million orphaned children are living in Kenya and 56 million orphaned children are living across sub-Saharan Africa. No empirical research has investigated meaningfulness of life among this population, and few studies provide perspectives on the life-course consequences of losing a parent during childhood.

Methods

In this study, we assess life meaningfulness in cross section of Kenyan women (n?=?1974) in a semi-rural area of the country (Meru County) collected during June 2015. We used two sets of mediation analyses to assess (1) whether meaningfulness of life was lower among women who reported a parental death during their childhood, and how this association was mediated by social support, family functioning, school completion and HIV+?status of household, and (2) the extent to which lower subjective overall health among women who experienced orphanhood during childhood was mediated by less meaningfulness of life.

Results

Women who experienced a parental death during childhood reported significantly less meaningful lives as adults. Lower social support and family functioning explained approximately 40% of the disparity. Women who experienced a parental death during childhood also had significantly worse subjective overall health, 18% of which was explained by lower meaningfulness of life.

Conclusions

Further study on life meaningfulness and family capital in the context of the orphan crisis in sub-Saharan Africa is warranted, and required to promote equity across the lifespan. Policy efforts to support orphans and vulnerable children should target strengthening support networks and family functioning to optimize self-reported health outcomes.

     

Extended family's and women's roles in safeguarding orphans' education in AIDS-afflicted rural Zimbabwe

The extended family forms the basis for orphan care and education in sub-Saharan Africa. Initial absence followed by emergence of differentials in primary school enrollment between orphans and non-orphans have been attributed to the strength and subsequent HIV/AIDS-induced breakdown of extended family orphan care arrangements. Yet, few attempts have been made to describe how these arrangements are affected by HIV/AIDS or how they relate to observed patterns of childhood outcomes by sex and orphan status. We use a combination of quantitative and qualitative data to show that maternal orphans but not paternal or double orphans have lower primary school completion rates than non-orphans in rural Zimbabwe, and that these patterns reflect adaptations and gaps in extended family orphan care arrangements. Sustained high levels of primary school completion amongst paternal and double orphans--particularly for girls--result from increased residence in female-headed households and greater access to external resources. Low primary school completion amongst maternal orphans results from lack of support from fathers and stepmothers and ineligibility for welfare assistance due to residence in higher socio-economic status households. These effects are partially offset by increased assistance from maternal relatives. These findings indicate that programmes should assist maternal orphans and support women's efforts by reinforcing the roles of extended families and local communities, and by facilitating greater self-sufficiency.     

Knowledge, attitudes and behaviours of health care workers towards clients of sexual health services in Fiji

A cross-sectional survey was conducted to identify the attitudes and behaviours of health care workers (HCWs) in health care settings (HCS) in Fiji involving 369 participants. Self-rated knowledge of HIV and sexually transmissible infections (STIs) varied depending on whether the HCS was divisional or sub-divisional, and varied between the various national divisions. HCWs with experience in HIV, reproductive health and antenatal clinics had higher self-rated HIV knowledge. A high proportion had a fear of catching HIV from HIV-positive clients. This study found high levels of negative attitudes towards clients from vulnerable groups with regards to the transmission and spread of HIV. Study participants also reported observing differential treatment by their colleagues if a client was known to have or was suspected of having HIV. There is a need for further HIV education of HCWs, with training focussed on occupational risk, and on reducing stigma and discrimination of those living with or vulnerable to HIV in Fiji.     

AIDS orphans and vulnerable children in India: problems, prospects, and concerns

This article reviews and discusses the problems, responses, and concerns of orphans and vulnerable children in India. The article shows that HIV/AIDS programs and interventions are vital for survival and welfare of orphan and vulnerable children, but they have reached only to a small fraction of the most vulnerable children. The article suggests a number of measures that government and civil society could take to address the problems and emphasizes the need to learn from other countries' experience and initiatives in developing appropriate policy and programmes for orphan and vulnerable children.     

School performance and school behaviour of children affected by acquired immune deficiency syndrome (AIDS) in China

It is generally recognized that the acquired immune deficiency syndrome (AIDS) epidemic will have a negative effect on orphans' school education. However, few studies have been carried out to examine the school performance and school behaviour of AIDS orphans and vulnerable children [children living with human immunodeficiency virus (HIV)-infected parents]. Using both self-report and teacher evaluation data of 1625 children from rural central China, we examined the impact of parental HIV/AIDS on children's school performances (academic marks, educational expectation and student leadership) and school behaviours (e.g. aggression, shyness/anxiety and assertive social skills). Results indicate that AIDS orphans and vulnerable children had disadvantages in school performance in comparison to their peers from the same community who did not experience AIDS-related death and illness in their family (comparison children). AIDS orphans had the lowest academic marks based on the reports of both children and teachers. From a teacher's perspective, educational expectation was significantly lower among AIDS orphans and vulnerable children than comparison children. AIDS orphans were significantly more likely to demonstrate aggressive, impulsive and anxious behaviours than non-orphans. Moreover, orphans have more learning difficulties. Vulnerable children were also at a disadvantage on most measures. The data suggest that greater attention is needed to school performance and behaviour of children affected by AIDS. The findings also indicate that AIDS relief and assistance programmes for children should go beyond school attendance and efforts should be made to improve their school performance and educational aspirations.     

Orphan and vulnerable children infected or affected by HIV/AIDS in Delhi – situational analysis and state government's initiative of household economic strengthening

HIV epidemic brought a terrible toll on children and families worldwide. There are 25 million orphans in India from all causes, of which approximately two million may be attributed to HIV/AIDS. National AIDS Control Organization (NACO), Government of India, recently started focusing on orphan and vulnerable children (OVC) through Children Affected by AIDS (CABA) Pilot Scheme in 10 districts of the country including one district of Delhi. This study was conducted to describe the situation of OVC infected or affected by HIV/AIDS in Delhi and the process followed by Delhi State AIDS Control Society (DSACS) to enable grant of financial assistance to OVC infected or affected by HIV/AIDS from Government of Delhi and its implementation thereafter with overall objective of household economic strengthening of people living with HIV/AIDS (PLHIV). The data during April 2010–March 2012 from nine antiretroviral treatment (ART) centers, CABA pilot scheme, and two institutions providing residential care to CABA in Delhi were analyzed. Total number of OVC in Delhi is estimated to be 1908 of which 766 are infected with HIV and 1142 are affected by HIV/AIDS. Through CABA Pilot Scheme, few OVC could be linked to existing Government Welfare Schemes due to lack of essential documents. Hence, DSACS planned a special financial assistance scheme for PLHIV to retain CABA in home-based care. In the first six months, 6.8% PLHIV, 11.7% children living with HIV/AIDS, 9% double orphan children infected with HIV/AIDS, 9% double orphan children affected by HIV/AIDS, and 68% destitute children infected with HIV/AIDS received benefit of the scheme. To maximize impact, efforts are being made to develop linkages of cash transfer households with other social service providers. Strength, Weakness, Opportunity & Threat (SWOT) analysis has been done with aim to improve the scheme. A national policy to address the cause of OVC infected or affected by HIV/AIDS is need of the hour.     

Attitudes towards and perceptions of reproductive health needs of persons living with HIV/AIDS in rural Kilimanjaro,Tanzania

The introduction of antiretroviral treatment has resulted in the resumption of socially productive and sexually active lives of people living with HIV/AIDS, together with the desire for children. However, factors affecting the reproductive health needs of people living with HIV/AIDS are not well understood. With this in mind, the aim of this paper was to investigate factors associated with these health needs using a qualitative approach. Findings indicate that attitudes and perceptions about reproductive health needs are influenced by fertility beliefs, the central role of family, procreation and the perceived social and clinical consequences of pregnancies among people living with HIV/AIDS. While there was mixed opinion about acceptability of people living with HIV/AIDS, having children, marriage and family were institutions important for partnerships maintenance and procreation. These findings suggest that living with HIV in a community with strong pro-life attitudes is challenging for people living with HIV/AIDS who do not have children. Apart from having to grapple with potential stigma of not having children, people living with HIV/AIDS also face social challenges in realising their reproductive choices. Interventions to address stigma, societal changes and the integration of reproductive-health education into HIV care and treatment are needed.     

Education among orphans and non-orphans in an urban area of Burkina Faso

Abstract

Africa has long dealt with issues surrounding orphanhood and the fostering of children whose parents are no longer alive or available. With the increasing impact of HIV reflected demographically throughout the world, the sociodemographic situation of orphans in sub-Saharan Africa has only grown in visibility and importance. This paper compares orphans and non-orphans living in an urban area of Burkina Faso (Bobo-Dioulasso), with a special focus on school enrolment and delay. We found in univariate analysis that orphans and non‐orphans are equally likely to be enrolled in school, but orphans are more likely to be delayed. Once controlling for sociodemographic differences, however, orphans are not delayed significantly in school when compared with non-orphans. Results suggest that, while orphans may be at educational risk due to other concomitant sociodemographic factors, in this urban area orphan status alone does not significantly predict educational enrolment and short-term outcome.     

Quality of life and psychosocial well-being among children living with HIV at a care home in Southern India

This study was designed to evaluate the quality of life (QOL) of children living with HIV at an institutional care home in Bangalore, India. The Sneha Care Home is a unique residence that provides educational and community support with a focus on physical, nutritional, medical, and psychological care for orphans and vulnerable children. Cross-sectional health measures and interview data were collected from 97 residents including 52 boys and 45 girls between 5 and 12 years of age (mean age = 9). QOL was measured with the Pediatric Quality of Life 4.0 (PedsQL) Inventory. Caregivers perceived children to have an overall higher QOL than was self-reported by children (total score 83 vs. 78). Our findings indicated self-reported QOL decreased with age of the child, while caregiver-reported QOL increased with age, suggesting a need to ensure greater psychological support for older children. Physical measures showed the children’s clinical severity of disease remained well controlled living in this residential, values-based care home.     

Changing patterns of orphan care due to the HIV epidemic in western Kenya

The HIV/AIDS epidemic has given rise to major demographic changes including an alarming number of orphans in sub-Saharan Africa. The study describes a rural community in western Kenya in which one out of three children below 18 years of age had lost at least one biological parent-and one out of nine had lost both. The main problems these children faced were lack of school fees, food and access to medical care. The high number of orphans has overwhelmed the traditional mechanisms for orphan care, which were based on patrilineal kinship ties. Thus, 28% of the orphans were looked after by culturally "inappropriate" categories such as matrilineal kin or strangers. Furthermore, many of the caretakers were themselves not capable due to ill health or old age. Factors such as poverty, negative attitudes, and traditional funeral customs made the orphans' situation even worse. The authors conclude that though community-based interventions are urgently needed as the most appropriate way to address the issue, the complex, local reality in which cultural factors, kinship ties, and poverty are interwoven needs to be taken into consideration if sustainable solutions are to be found.     

Perceived social support of HIV/AIDS orphans: a review

HIV/AIDS orphans are a vulnerable and disadvantaged group. The HIV/AIDS orphans’ crisis is an emerging problem of developing societies. Existing research, literature, and findings on perceived social support (PSS) of HIV/AIDS orphans in the world till date have been compiled with the aim of presenting the current status of research, major findings, and gaps in this area. A thorough review of published empirical studies from PubMed, PsycINFO databases, online publications of several organizations, web searches, and several online journals related to PSS of HIV/AIDS orphans have been reviewed. HIV/AIDS orphans from 6 to 18 years, whose either or both parents had died due to HIV/AIDS or were staying with HIV-positive parents were selected for this purpose. Six out of eight studies found low level of PSS in HIV/AIDS orphans and two studies found peer-group intervention very effective to improved PSS in HIV/AIDS orphans. They severely experience negative emotions, behavioral problems, higher levels of psychological difficulties, and poor academic performances due to the reasons like drawn out-of-school, living with an unaffectionate caretaker, inadequate care, child labor, physical and sexual abuse, stigma, and discrimination. The psychological health of HIV/AIDS orphans is at risk, and prevention and intervention efforts are missing for improving their psychological outcomes. The review recommends that a rigorous research needs to be prioritized so that the programs and policymakers that are attempting to work for their well-being may get helpful information to design evidence-based interventions.     

The social situation of motherless children in rural and urban areas of Guinea-Bissau

With the increasing prevalence of HIV infection and the high maternal mortality, orphans are a rapidly growing problem in Africa. However, few studies describe the social conditions of these children. Our study focuses on motherless children in urban and rural areas of Guinea-Bissau. A rural and an urban cohort of children (128 and 192, respectively) that had been followed by demographic surveillance since 1990 were identified and the relatives of these children interviewed. A control cohort of 808 individuals was also identified. Although orphan children remained disadvantaged, there were few differences between surviving motherless and control children in nutritional status, use of health care services, school attendance, quality of housing, and clothing. Motherless children moved more frequently and were more likely to live in small families, often with an older grandmother. The traditional extended family system appears to be capable of handling motherless children in a non-discriminatory fashion. However, the AIDS epidemic will continue to stress the extended family system and social services to the limit.